EA188386 - Plumbing - Single Fam - Issued Date 12/06/2023 PERMIT
City of Eagan Permit"': Plumbing
3830 Pilot Knob Rd ,,�;; %e;A�,. Permit Number: EA188386
Eagan,MN 55122 `-••
(651)675-5675 111111111111 IN 11111111111111111111111111111111
www.cityofeagan.com * E R 1 8 8 3 8 6 k
Date Issued: 12/6/2023
Site Address: 1273 Interlachen Dr
Lot: 7 Block: 2 Addition: Dakota Path 5th
PID:10-19544-02-070
Use: * 10 — 19544 - 0Z - 070
Description:
Sub Type: Single Fam
Work Type: Alteration
Description: plumbing for basement finish
Meter Size Meter Ty
pe Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: PL-Plumbing Permit Fee $64.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
Total: $65.00
Contractor: Owner: - Applicant -
Uday Sambhara
1273 Interlachen Dr
Eagan MN 55123
This permit shall be null and void if work does not start within 180 days of issuance,or if work is suspended for 180 days or more after
started.
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature Issued By: Signature
-----------------
9 e For Office Use I
�'® �'R I 188386
�s n0 ARL EL I Permit#:
A[ 3111111
EAGI�% I I
Permit Fee: I
12/6/2023 I
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 FAX: (651)675-5694 I Staff:
buildinginspectionscD-cityofeagan com L----------------
RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 11/20/2023 Site Address: 1273 interlachen Dr. , Eagan, MN-55123
Unit#:
Applicant is: ® Owner El Contractor
�,...�.... me:�U d ay Sa m b ha ra
Homeowner Address: 1273 Interlachen Dr. Eagan
City:
I State: MN Zip: 55123 Phone Email:408.203.5355 uday.sambhara@gmail.com
,
Type of Work_ —New _Replacement _Repair _Rebuild ✓ Modify Space —Work in R.O.W.
Description of.work: plumbing roughed in for basement finish
Tankless Water Heater
Standard Water Heater
Lawn Irrigation (_RPZ/_PVB)Description Water Softener V( Add Plumbing Fixtures(_Main/_Lower Level)
Septic System Description:rough in for bathroom kitchen $
New Abandonment
Connection to City Water from Well
�
Company: Contact:
Plumbing Address: City:
Contractor.'`
State: Zip: Phone: Email:
mm�License#: Expiration Date:
RESIDENTIAL FEES
$150.00 New Residential or Connection to City Water(includes State Surcharge)
$65.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$65.00 Lawn Irrigation (includes State Surcharge)
$65.00 New fixtures, adding, altering, or removing piping (includes State Surcharge)
$65.00 Septic System Abandonment(includes State Surcharge)
TOTAL FEES $
CALL BEFORE YOU DIG. Contact Gopher State One Call at(651)454-0002 or www.00pherstateonecall.oro for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
XUday Sambhara S
X ,
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE
Reviewed By: Date:
Meter Size(if applicable):
Required Inspections: Under Ground Rough-In Air Test Gas Test Manometer Final